损伤控制性复苏对严重多发伤患者生存预后的影响

Effect of impaired controlled recovery on survival outcomes in patients with severe multiple injuries

目的探讨损伤控制性复苏对严重多发伤患者生存预后的影响。方法回顾性选取于2018年7月~2021年7月在本院急诊科就诊的412例严重多发伤患者的临床资料进行分析,根据干预方案将患者分为对照组和观察组,各206例。对照组采取积极的液体复苏联合损伤控制性手术,观察组采用损伤控制性复苏策略。采用全自动生化分析仪测定两组患者的凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、乳酸(LA)水平、剩余碱(BE)。随访3个月,根据随访结果,将由于严重多发伤死亡的患者作为死亡组,其余患者作为存活组,观察并统计两组患者的生存天数。通过Kaplan-Meier法进行生存分析且行Log-rank检验,预后生存的影响因素采用Logistic回归分析。结果观察组PT、APTT、LA水平均低于对照组(P<0.05),BE水平高于对照组(P<0.05)。经3个月的随访,观察组206例患者中共死亡4人,平均生存时间为(40.16±5.23)d;对照组患者死亡8人,平均生存时间为(30.26±2.06)d,两组生存时间比较差异有统计学意义(χ^(2)=15.577,P<0.05)。不同年龄、创伤严重度评分(ISS)、受伤到就诊的时间、补液量、输血量、是否休克的生存患者和死亡患者的比例比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄、ISS、受伤到就诊的时间、是否休克、补液量、输血量为严重多发伤患者预后生存的独立影响因素(P<0.05)。结论损伤性控制复苏策略可有效改善严重多发伤患者的凝血功能,减少对患者内环境的干扰,改善患者预后。

Objective To investigate the effect of impaired controlled recovery on survival prognosis in patients with severe multiple injuries.Methods The clinical data of 412 patients with severe multiple injuries who were treated in the emergency department of our hospital from July 2018 to July 2021 were retrospectively selected for analysis.According to the intervention plan,the patients were divided into a control group and a study group,with 206 cases in each group.Active fluid resuscitation combined with injury control surgery was used in the control group,and injury control resuscitation strategy was used in the study group.Fully automated biochemical analyzer to determine prothrombin time(PT),activated partial PTT time(APTT),lactate(LA)level,residual base(BE)for 3 months.According to the follow-up results,the patients who died due to severe multiple injuries were regarded as the death group,and the patients who did not die within 3 months were regarded as the survival group,and the survival days of the two groups were observed and counted.Survival analysis was performed by Kaplan-Meier method and Log-rank test was performed,and logistic regression analysis was used for the influencing factors of prognosis and survival.Results The levels of PT,APTT and LA were lower than those in the control group(P<0.05),The BE levels were higher than those in the control group(P<0.05);After 3 months of follow-up,A total of 4 people died in 206 patients in the study group,The average survival time was(40.16±5.23)d;Eight patients died in the control group,The average survival time was(30.26±2.06)d,The Logrank analysis chi-square value for both groups was 15.577,The P-value is 0.000,The difference was significant(P<0.05).There were significant differences in the proportion of surviving patients and dead patients with different ages,ISS score,time from injury to treatment,fluid replacement volume,blood transfusion volume,shock or not(P<0.05).Logistic regression analysis showed that age,ISS score,time from injury to hospital visit,shock,fluid volume,and blood transfusion were independent prognostic factors for the survival of patients with severe multiple injuries(P<0.05).Conclusion The injury control resuscitation strategy can effectively improve the coagulation function of patients with severe multiple trauma,reduce the disturbance to the patient's internal environment,and improve the prognosis of the patient.